Why Global Funding Needs a New Strategy Now  

Anyone seeking evidence that the current system for funding global health and other vital initiatives is failing should consider the world’s response to COVID-19. To date, there have been more than 615 million cases reported, and 6.5 million deaths, while vaccination rates have been profoundly inequitable around the world.  In a series of reports published recently in The Lancet, authors characterized the pandemic and its response as both “a profound tragedy and a massive global failure at multiple levels.” 

Now, a growing international collaborative is reimagining public investment around the world.  A new Global Public Investment Network, launched September 19 during the United Nations General Assembly, aims to move away from “an old-fashioned aid mentality” toward a new common framework for financing the most critical social, economic, and environmental challenges in rich, poor, and middle-income countries alike. According to the network’s organizers: “GPI is a co-created movement with leadership from every region of the world. It is a movement for evolving beyond aid and leveraging significantly increased international public finance to meet the common needs we all care about through the principles of ‘all contribute, all benefit, and all decide.’” 

Alicia Ely Yamin, a lecturer on law at Harvard Law School as well as PIH’s senior advisor on human rights and health policy, and Joel Curtain, director of advocacy for PIH, have been centrally involved in the development of the GPI Network. We spoke with them to find out more about the bold ideas driving this movement, including a recent article in Open Global Rights they co-authored, laying out the moral underpinnings of the campaign. 

What is Global Public Investment? 

GPI is a simple concept: all countries pay in to a pool according to ability; all receive benefits; and all have a say in how the money is spent. Global Public Investment (GPI) is about spending on global and regional public goods—common needs that transcend borders. This model shifts away from the status quo, in which decision-making is concentrated among a handful of Global North countries, to one that takes democratic decision-making seriously.   

How does GPI align with PIH’s overall mission? 

Since PIH’s founding as a social justice organization, our work has involved direct service delivery in resource-limited settings while working hand-in-hand with governments to ensure access to high-quality health care for all. PIH has simultaneously engaged in policy advocacy efforts to fight the status quo around financing health care where policy makers and world leaders have become socialized to scarcity when imagining what it will take to ensure the human right to health.

In the early days of PIH, Co-founder Dr. Paul Farmer received a MacArthur Genius Award and created the Institute for Health and Social Justice within Harvard Medical School, where he and [fellow Co-founder] Dr. Jim Kim worked together with scholars from around the world to publish books, such as "Dying for Growth," which challenged the current health and development financing structures that had become the norm in the neocolonial development financing arena. In the midst of the COVID-19 pandemic, we’ve reinvigorated our organizational engagement and commitment to advocating more deeply for structural change and we believe that the Global Public Investment principles are on the right path toward a structure of global solidarity rather than charity.  

Why is there momentum on GPI now? 

The way aid is handled now is basically as crisis-based charity; it’s politicized and counterproductive and there are huge transaction costs. GPI started as an idea a few years ago and now there’s a huge amount of attention and a window of opportunity to move toward a new model of financing. 

The world is ripe for a paradigm shift in development finance and lessons from the COVID-19 pandemic underscore that building a movement to shift that paradigm is urgent in order to advance health and other social rights.   

How did the pandemic crystallize thinking about GPI? 

COVID-19 brought the world’s attention to how desperately underfunded health systems are in much of the world. All of the other social determinants of health that shape how diverse people can manage in a pandemic or normal times, from education to social protection to digital networks, also require sustained funding and long-term investments. 

We also saw that our system of multilateral cooperation is deeply broken, and talk of “international assistance and cooperation” without changing the rules of the game are radically inadequate. In the piece published recently in OGR, we noted that: "the G7 countries’ refusal to meaningfully regulate multinational pharmaceutical monopolies or to encourage sharing of know-how and decentralization of vaccine and therapeutics production is not just morally repugnant; it undermines the well-being of the whole planet.” Instead of incentivizing technology transfers and knowledge-sharing as global public goods, “COVAX was a poorly designed emergency facility for pooling donated vaccines, which failed to meet even its dismally low aspirations for low- and middle-income countries.” 

As we noted in our article, “preventing future pandemics and advancing global health equity is inextricably tied to food security and climate justice, which in turn is also related to conflict and gender inequality.”

None of these intersecting challenges can be met through crisis-driven aid and rituals of fund replenishment; all require statutory budget assignments for sustained global and/or regional public investment from pooled international sources. 

How is PIH involved in these efforts? 

For the last two years, Partners In Health, along with many other organizations, has contributed to co-creating the GPI model because we believe it is a crucial complement to the many other efforts to promote structural conditions that underpin health and other social rights, including tax justice, debt forgiveness, intellectual property reform, and principles of rights-based economies.  .   

Realizing health for all, and responding to our global crises, requires new forms of global cooperation. These new forms of cooperation must: 1) deliver global economic justice, i.e. stop illicit extraction and unjust drain of wealth from poor countries to rich countries and 2) mobilize and distribute public resources on a global basis, i.e. global public investment. 

Why have these goals been so difficult to achieve through the current system of aid? 

The dominant narrative of aid tells us that poor countries are poor due to some inherent failing and that rich countries benevolently provide assistance to them. Not only is this untrue, but it also serves to hide the brutal reality that it is actually poor countries that develop rich ones, through unjust and illegal resource flows. What is required is justice and solidarity, not charity.  

Mobilizing and distributing public resources on a global scale requires new levels of global solidarity and requires reimagining global cooperation and the very conception of international development. Currently, the global health architecture promotes narrowly defined programs that are in misalignment with local needs, are highly fragmented, and ultimately entrench low standards of care that are deemed “appropriate” in poor settings but would be unacceptable in rich ones. This reality, in which 13 million people die medical preventable deaths each year, is a consequence of an unjust global economy and a lack of global public investment to build health systems that deliver high quality care. 

Strengthening health systems is a central pillar of PIH’s strategic plan and necessary for realizing universal health care. The principles of GPI can help with such a transformation toward a more equitable and effective mode of multilateral cooperation fit for the 21st century. 

How do you build momentum for such a movement? 

The launch of the GPI Network this week is the first step in building a movement for GPI. GPI principles are already gaining traction in policy-making, advocacy, and scholarly communities, for example  the World Bank’s new fund for pandemic preparedness and response, as well as climate finance. But GPI cannot become another tool for technocrats to discuss and deploy behind closed doors. We need a GPI movement that intersects with other progressive movements, including human rights, which are aimed at changing the structure of our institutionalized social order.

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